Francisco is sitting up in bed wearing ear phones focused on his iPad. Wendy, his granddaughter, says, “He’s watching a YouTube video,” and smiles at my reaction. My preconceived notions of a ninety-one-year-old man diagnosed with terminal cancer prepared me for a more sombre mood. Surprisingly upbeat, Francisco is willing to get out of bed and meet me in the lounge with Wendy to share his
end-of-life journey.
Francisco came to Canada from Portugal in 1974. Eventually, he settled in Toronto, where he came to work for a landscaping company. He retired at sixty-five, but the landscaping company hired him back for another four years because they needed his expertise.
He has been widowed for over fifteen years, and three years ago his son passed away. Wendy, now forty-one, has been living with her grandfather all her life. Both she and her mother, Fatima, are very involved with Francisco’s care. It seems he was also very involved in theirs. During our discussion, Francisco smiles at Wendy, and recalls babysitting her when she was younger. Wendy adds that he was legendary among the family for his babysitting skills. “In fact, some of the women in our family believed he was better at child care than they were.”
In early November 2018, Francisco was having difficulty swallowing; his appetite had decreased, and he had lost weight. He was admitted to the University Health Network’s Toronto Western Hospital (TWH), where a computed tomography (CT) scan revealed that Francisco had urothelial cancer (a cancer of the urinary system). He was told it was terminal, and shortly after he was discharged.
A few days later, however, he returned to TWH — this time because of a bladder infection. He remained at TWH for treatment. During this time, he came to accept that his cancer was terminal. Wendy says, “One minute we were taking him to the hospital because he’s having problems swallowing, and then we receive news that he has cancer and it’s terminal; it was a little overwhelming.” Wendy and her family then decided that perhaps her grandfather should be in a palliative care facility. “We chose The Salvation Army Toronto Grace Health Centre (TGHC) because of its location and accessibility,” according to Wendy, “but, honestly, we didn’t realize that a wonderful facility like this existed.
“When he was first admitted to TGHC, he was bedridden,” recalls Wendy. “My family and I, as well as my grandfather, came to accept that his end-of-life journey would take place here at the Toronto Grace.” But Francisco began to take on his activities of daily living again — getting out of bed, transferring to his wheelchair, going to the washroom by himself; slowly he was gaining back his independence. Currently, he is able to move about using his walker. “The nurses,” says Wendy, “who by the way are phenomenal, do help with his bathing, but his mobility has gotten so much better. In fact, my grandfather is so much more independent now that we’ve made plans to take him home. It was amazing for us to have come here to the Toronto Grace, and although we know his cancer is terminal, being here has given him the will to live.”
Francisco will be returning to live in a new home that Wendy and her husband have purchased. His family is happy that he is returning home, especially Wendy, who says, “The new home is better suited to his needs; more importantly though, he will be surrounded and supported by his family in his end-of-life journey.” Before Francisco’s discharge, the TGHC’s palliative care team ensured that he would be connected with the Community Palliative Care Team, as well as the Toronto Central Local Health Integration Network (LHIN) home and community care services. Both services will provide health care professionals who will assist Francisco at home.
Francisco wanted to have a party to celebrate returning home. When he found out that his discharge date fell on Monday, March 25, 2019, he told Wendy to get his discharge date changed. “Monday,” Francisco said, “is not a good day for a party. “He was discharged on Friday, March 22, 2019.